Arriving on the eighth floor, Carl was immediately encouraged by the general peacefulness as he walked quickly and silently down the long, dimly lit hallway. At that moment on that particular floor it was as if the hospital was deserted, save for an occasional nurse or aide coming out of one distant room and then quickly disappearing into another. Most of the rooms he passed were silent and dark, although there were a few where the lights were on and even a few where the quiet sound of the TVs drifted out into the corridor. Near the far end of the corridor he could plainly see the nurses’ desk because it stood out starkly as the only area brightly illuminated. Behind the counter-high barrier, he could just make out several heads either of nurses, aides, or clerks, who were most likely busy with data entry or paperwork.
Slowing down and then stopping when he came abreast of room 838, he noticed the door was nearly closed with but a half-inch gap between the door and the jamb. Pausing for a moment, he reached into his pocket to fondle the syringe loaded with the KCl just to reassure himself it was there waiting for him. After glancing up and down the hallway to make sure the coast was completely clear and his presence hadn’t attracted any attention, he used just the tips of his fingers to push gently against the door, slowly and silently opening it. Progressively the darkened room came into his view and ultimately the hospital bed. What caught Carl’s eye first, in addition to the dark-haired woman sleeping in the bed, was that her ECG was being continuously displayed on a monitor mounted in the wall behind and above the head of the bed. He thought this was convenient as it would immediately reflect the ventricular fibrillation and sound an alarm. Carl liked the idea of an alarm being involved as it would provide an explanation of why he had dashed into the room, if anyone were to ask. The other important thing he noticed was that there still was an intravenous line snaking into Laurie’s arm. If that had been removed, he might have had to scrap the entire plan and come up with a new idea. But he had been confident it would be there as normal protocol dictated it.
With a final glance up and down the corridor, he pushed open the door enough to allow him to step silently into the room. Pausing for a moment to allow his eyes to fully adjust to the relative darkness, he glanced around at the rest of the interior. Suddenly he froze. With an unpleasant sense of shock, he noticed a second occupant in the room. Curled up in a fetal position on a small couch was a man who Carl immediately assumed was Laurie Montgomery’s husband, Jack Stapleton, with whom he’d spoken on the phone that afternoon.
Carl’s first inclination was to immediately flee as this was an unexpected and unfortunate change in the circumstances. But he hesitated, silently telling himself that perhaps it wasn’t quite as bad as he had initially feared and might actually help to deflect attention once the feverish activity of the resuscitation attempt was initiated. On top of trying to save the patient, the resuscitation team and the floor nurses inevitably would have to deal with the aggrieved husband.
What had brought all this to his mind after the initial concern was recalling how rapidly the fibrillation would occur. Just like he had done in the ICU, Carl would start resuscitation immediately. By the time the husband would wake up, orient himself, and get over to the bedside, Carl could already be giving external cardiac massage, saying he’d heard the alarm while passing by in the hallway. If anything, the husband, as a physician himself, would surely participate, perhaps by giving mouth-to-mouth respiration. Suddenly Carl was so confident, he found himself smiling at the mental image of him and the husband trying to save the doomed Laurie. Carl knew full well that once the bolus of KCl was in her system and wasn’t immediately reversed, there was no way for the cardiac conduction system to function, no matter what any resuscitation team tried to do.
For another minute Carl continued to stand in the middle of the dark room as he rethought the entire scenario. When he did so, he was even more convinced that having Stapleton unexpectedly present actually afforded a way around the problem of his getting away after the deed had been done. It had worked like a charm in the ICU, but that was because there were so many people involved. Here on the private floor there would be far fewer people, particularly fewer staff doctors since the entire resuscitation team was composed of residents, mostly in internal medicine, and Carl’s presence would stand out, especially if someone questioned whether he had any private patients on the floor. As for Jack Stapleton recognizing him, he thought the chances were essentially zero. He doubted they had ever met, but even if they had, with his wig and dark glasses, Carl didn’t even recognize himself.
Fully reassured of his plan, he silently advanced up along the right side of Laurie’s bed. For a moment, as he listened to Laurie’s regular breath sounds in the darkness, he glanced up at the ECG as it metronomically traced its normal squiggle across the screen. He inwardly smiled as he anticipated that in a few seconds the tracing would suddenly change into the sinusoidal jumble of ventricular fibrillation, meaning the entire heart’s electrical conduction system had devolved to pure chaos.
Carl pulled the loaded syringe out. The meager light coming from the bathroom was just enough to make sure it was still entirely full. Using his teeth, he pulled off the plastic protective cap from the large-bore needle. After one more glance back at the sleeping husband who’d not moved a muscle or made a sound, Carl picked up the IV line with his left hand so that with his right hand he could insert the needle into the IV port. Holding the syringe in both hands, with both thumbs on the plunger, and after one more quick glance at Jack Stapleton’s sleeping form, he rapidly injected the entire contents into Laurie’s intravenous line. As with Madison Bryant, the level in the drip chamber rose suddenly as a bit of the KCl traveled retrograde. In the next instant he opened the IV line completely, letting it run free.
As he had anticipated, almost simultaneous with his withdrawing the syringe, he saw the initial changes appear on the ECG tracing that included a dramatic upward shift of the T wave. With the very next beat it was worse. Two beats later the entire normal ECG complex disintegrated into a kind of chicken scratch or child’s scribble to reflect that the heart had stopped beating and had become a quivering mass of muscle. At the same time the cardiac alarm went off to shatter the room’s silence, causing Carl to start despite his fully expecting it.
Vaguely aware of the figure on the couch leaping up, Carl quickly pocketed the empty syringe and then collapsed the safety rail to facilitate his climbing onto the bed to start closed chest massage. He couldn’t have been more confident and more content. For him it was a kind of confirmation of the scientific method as things were going like clockwork. He knew full well that first one of the nurses, followed by one of the hospital’s on-call resuscitation team, would be rushing into the room in a matter of seconds to take over what would turn out to be a hopeless task.
Jack initially tried to avoid waking up because he was in the middle of one of his favorite dreams. He was playing basketball, but he wasn’t playing the way he normally played in real life. He was playing a type of basketball where he was capable of jumping so high that he could hang in the air and easily dunk. Even when he’d been at his physical peak somewhere around age seventeen, although he could manage to touch the rim with ease, he could never dunk because he couldn’t palm the basketball. Yet despite the enjoyable high the dream engendered, the raucous sound of the ventricular fibrillation alarm, which he initially had incorporated into his dream, finally yanked him into full wakefulness. Becoming oriented to time, place, and person, he leaped off the couch.